Novel tlr4 inhibitors for the treatment of human infectious and inflammatory disorders

ABSTRACT

The present invention relates to methods of treating infectious, inflammatory and post-traumatic disorders by administering various compounds newly discovered to have TLR4 inhibitory activity. In addition to methods of treatment, the present invention further provides for pharmaceutical compositions comprising said compounds, together with a suitable pharmaceutical carrier. Because TLR4 is the most upstream receptor in the pro-inflammatory LPS signaling cascade, treatments of the invention, which inhibit or antagonize TLR4 action, may avoid the pitfalls associated with other cytokine inhibitors that act further down the pathway and accordingly play a less specific (and perhaps non-critical) role.

PRIORITY CLAIM

This application is a continuation of U.S. patent application Ser. No.16/386,886, filed Apr. 17, 2019, which is a continuation of U.S. patentapplication Ser. No. 15/383,625, filed Dec. 19, 2016, now U.S. Pat. No.10,300,083, issued on May 28, 2019,which is a continuation of U.S.patent application Ser. No. 14/717,349, filed May 20, 2015, now U.S.Pat. No. 9,532,999, issued on Jan. 3, 2017, which is a continuation ofU.S. patent application Ser. No. 13/848,809, filed Mar. 22, 2013, nowU.S. Pat. No. 9,072,760, issued on Jul. 7, 2015, which is a continuationof International Patent Application Serial No. PCT/US2011/053293, filedSep. 26, 2011, which claims priority to U.S. Provisional ApplicationSer. No. 61/386,345, filed Sep. 24, 2010, and to U.S. ProvisionalApplication Ser. No. 61/387,335, filed Sep. 28, 2010. The contents ofeach of the foregoing are incorporated by reference in their entireties.

GRANT INFORMATION

Federal funding was not used in the development of the subject matter ofthe invention.

INTRODUCTION

The present invention relates to methods of treating infectious,inflammatory and post-traumatic disorders by administering variouscompounds newly discovered to have TLR4 inhibitory activity.

BACKGROUND OF THE INVENTION

The innate immune receptor Toll-like receptor 4 (“TLR4”) has beenrecognized to be the receptor on hematopoietic and non-hematopoieticcells for endotoxin (lipopolysaccharide, “LPS”) as well as a variety ofendogenous molecules that are released within the body duringinflammatory or infectious disorders. Strategies to discover moleculesthat are capable of neutralizing the ability of TLR4 to signal arelikely to show promise as novel anti-infective and/or antiinflammatoryagents.

SUMMARY OF THE INVENTION

The present invention relates to methods of treating infectious,inflammatory and post-traumatic disorders by administering variouscompounds newly discovered to have TLR4 inhibitory activity. Compoundsthat may be used according to the invention are set forth in TABLE 1,below. In addition to methods of treatment, the present inventionfurther provides for pharmaceutical compositions comprising saidcompounds, together with a suitable pharmaceutical carrier. Because TLR4is the most upstream receptor in the pro-inflammatory LPS signalingcascade, treatments of the invention, which inhibit or antagonize TLR4action, may avoid the pitfalls associated with other cytokine inhibitorsthat act further down the pathway and accordingly play a less specific(and perhaps non-critical) role.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1A-B. NFkB luciferase reporter mice treated with either (A) LPS(positive control, left) or saline (negative control; right) or (B)Bay-11-7082+LPS (left) or compound 1+LPS (right), imaged using the IVISLumina 3D Optical system.

FIG. 2A-B. NFkB luciferase reporter mice treated with either (A) LPS(positive control, left) or saline (negative control, right) or (B)compound 3+LPS (left) or compound 2+LPS (right), imaged using the IVISLumina 3D Optical system.

FIG. 3A-C. Intestines from NFkB luciferase reporter mice of FIGS. 1A-Band 2A-B, in particular (A) mice treated with LPS (left) or saline(right) or (B) Bay-11-7082+LPS (left) or compound 1+LPS (right) or (C)compound 2+LPS or compound 3+LPS (left), imaged using the IVIS Lumina 3DOptical system.

FIG. 4A-B. NFkB luciferase reporter mice treated with either (A) saline(left) or LPS (right) or (B) compound 4+LPS, imaged using the IVISLumina 3D Optical system.

FIG. 5. NFkB luciferase reporter mice treated with either saline (left),compound 5+LPS (center) or compound 6+LPS (right) imaged using the IVISLumina 3D Optical system.

FIG. 6A-B. Intestines from NFkB luciferase reporter mice of FIG. 4A-B,in particular mice treated with (A) saline or (B) LPS (left) or compound4+LPS (right), imaged using the IVIS Lumina 3D Optical system.

FIG. 7A-B. Intestines from NFkB luciferase reporter mice of FIG. 5, inparticular mice treated with (A) saline or (B) compound 5+LPS (left) orcompound 6+LPS (right), imaged using the IVIS Lumina 3D Optical system.

FIG. 8A-B. Summary of results of FIGS. 1-7, above.

FIG. 9A-B. ELISA results showing IL6 production. (*) denotes theendotoxicity score, where 0=healthy, 1=mild, 2=moderate, 3=severe, and4-lethal. Highlighting denotes particular “hits” of interest.

FIG. 10A-B. NFκB luciferase reporter mice treated with either (A) LPS(in the animal on the right with an animal treated with saline controlon the left) or (B) LPS plus compound (with the animal on the righttreated with C34+LPS and the animal on the left treated with C16+LPS).

FIG. 11. iNOS mRNA levels in breast-fed (BF) controls and a CFW-NECmodel induced by formula feeding (FF).

FIG. 12. TNFα mRNA levels in human NEC tissue explants treated with LPSas compared to LPS+C34.

FIG. 13. iNOS mRNA levels in human NEC tissue explants treated with LPSas compared to LPS+C34.

FIG. 14. TLR4 mRNA levels in breast-fed untreated or C34-treatedcontrols as compared to formula-fed (CFW-NEC) rats that were untreatedor treated with C34.

FIG. 15A-B. (A) AST levels in control animals as compared withhemorrhage-shock (H/S) model animals, and H/S animals treated with C34.ALT levels in control animals as compared with hemorrhage-shock (H/S)model animals, and H/S animals treated with C34

DETAILED DESCRIPTION OF THE INVENTION

For purposes of clarity and not by way of limitation, the detaileddescription of the invention is divided into the following subsections:

(i) TLR4 inhibitory compounds;

(ii) pharmaceutical compositions;

(iii) disorders that may be treated; and

(iv) methods of treatment.

TLR4 Inhibitory Compounds

Compounds that may be used to inhibit TLR4 (also referred to herein as“T4ICs”) according to the invention are set forth, below, in TABLE 1.

In specific, non-limiting embodiments of the invention, compounds thatmay be used to inhibit TLR (“T4Ics”) include compounds 1, 3, 4, 5, 6, 8,16, 21, 22, 27, 28, 29, 30, 45, and 47.

In one specific, non-limiting embodiment of the invention, the T4ICcompound is compound 3, which is4-O-(3-O-{2-(acetylamino)-2-deoxy-4-O-(6-deoxyhexopyranosyl)-3-O-[2-O-(6-deoxyhexopyranosyl)hexopyranosyl]hexopyranosyl} hexopyranosyl)hexopyranose, having thestructure:

In another specific, non-limiting embodiment of the invention, the T4ICcompound is compound 4, which is 3-acetamido-4,5-dihydroxy-6-(hydroxymethyl)tetrahydro-2H-pyran-2-yldihydrogen phosphate, sodium salt, having the structure:

In another specific, non-limiting embodiment of the invention, the T4ICcompound is compound 8, cyclohexanamine compound with1,6-di-O-phosphono-beta-D-glycero-hexopyranose (4:1) hydrate, having thestructure:

In another specific, non-limiting embodiment of the invention, the T4ICcompound is compound 16, 2-(acetylamino)-2-deoxy-D-galactopyranosehydrate, having the structure:

In another specific, non-limiting embodiment of the invention, the T4ICcompound is compound 27,2-(acetylamino)-2-deoxy-4-O-hexopyranosylhexopyranose, having thestructure:

In another specific, non-limiting embodiment of the invention, the T4ICcompound is compound 34, isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside, having thestructure:

In related non-limiting embodiments, the present invention provides forderivatives of isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside. In one set ofnon-limiting embodiments, said derivatives may have FORMULA I, asfollows:

where R is selected from R¹ and —O—R¹, where R¹ may be a substituted orunsubstituted alkane or alkene, where the substituent if present may bemethyl or ethyl, where the alkane or alkene portion optionally comprisesa branched or cyclic component, and may have between 1 and 12 or between1 and 6 carbon atoms.

In further non-limiting embodiments, said derivatives may have FORMULAII, as follows:

where R is selected from R¹ and —O—R¹, where R¹ may be a substituted orunsubstituted alkane or alkene, where the substituent if present may bemethyl or ethyl, where the alkane or alkene portion optionally comprisesa branched or cyclic component, and may have between 1 and 12 or between1 and 6 carbon atoms.

In specific, non-limiting embodiments, a derivative of isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside may be selectedfrom the following group of compounds:

In particular non-limiting embodiments, isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside may be preparedby the following method:

A working example containing further details of the synthesis is setforth below as section 9, Example 4, and is incorporated by referenceherein.

The present invention provides for pharmaceutical compositionscomprising therapeutically effective amounts of any of the foregoingcompounds, for example but not limited to together with a pharmaceuticalcarrier such as water or other physiologic solvent. A therapeuticallyeffective amount inhibits TLR4.

A compound is considered to inhibit TLR4 (that is, be a T4IC) if itinhibits one or preferably more sign or symptom of inflammation, suchas, for example, activation of NFkB, increased expression/levels ofinterleukin 6 (“IL-6”), elevated erythrocyte sedimentation rate,elevated C reactive protein, fever, tachypnea, lethargy, swelling,redness, and/or pain. The ability for a compound and/or a particularconcentration of a compound to inhibit TLR4 may be determined using anassay for TLR4 activity which may assess one of the abovelisted signs orsymptoms. For example, TLR4 inhibition may be assayed using a methodthat measures the affect of a compound on NFkB activity, for example,but not limited to, the NFkB luciferase reporter mouse model, stimulatedwith a TLR4 ligand such as LPS, described in the example below orHEK-Blue-4 cells (InvivoGen). As other non-limiting examples of systemsfor testing compounds to determine TLR4 inhibitory activity, CWT micemay be treated with LPS and a test compound and monitored for signs andsymptoms of inflammation, and/or C3H/WT cells (InvivoGen) may be treatedwith LPS and a test compound and tested for NFkB activation, IL6production, or other markers of the inflammatory process.

Pharmaceutical Compositions

The present invention provides for pharmaceutical compositionscomprising a T4IC, as described above, in a suitable pharmaceuticalcarrier. . The amount of T4IC present in the composition may becalculated to provide, when administered to a subject in need of suchtreatment, an effective amount of T4IC.

In non-limiting embodiments, the T4IC may be comprised in a coatedparticle, micelle, liposome, or similar structure.

A pharmaceutical composition may be a liquid, comprising a T4IC in aliquid pharmaceutical carrier comprising, for example, water (an aqueouscarrier) or saline. Said liquid composition may optionally furthercontain one or more of a buffer or a preservative.

Alternatively, a pharmaceutical composition may be a solid, for examplein the form of a tablet, capsule, sachet or suppository, comprising adose of T4IC that provides an effective amount of T4IC to a subject inneed of such treatment when administered according to a dosing regimen.Said solid pharmaceutical composition may further comprise one or moreexcipients, for example, but not limited to, lactose, sucrose, mannitol,erythritol, carboxymethylcellulose, microcrystalline cellulose,hydroxypropylmethylcellulose, starch, polyvinylpyrrolidone, etc

A pharmaceutical composition according to the invention may, innon-limiting embodiments, comprise an additional agent that may haveantimicrobial and/or antiinflammatory activity, for example, but notlimited to, an antibiotic agent, a steroid, or a non-steroidalantiinflammatory agent. In additional non-limiting embodiments of theinvention, a pharmaceutical composition may comprise an analgesic agent.In additional non-limiting embodiments of the invention, apharmaceutical composition may comprise an agent that improves cardiacfunction and/or reduces cardiac stress, for example, but not limited to,an angiotensin converting enzyme inhibitor, a beta blocker,nitroglycerin or a related nitrate compound, digoxin or a relatedcompound, or a calcium channel blocker.

Disorders that may be Treated

The present invention may be used to treat any disease/disorder(“disorder”) involving TLR4 activation, including, but not limited to,infectious diseases and inflammatory disorders such as sepsis,necrotizing enterocolitis, autoimmune diseases, Crohn's disease, celiacdisease, ulcerative colitis, rheumatoid arthritis, cardiovasculardisease including myocardial infarction, epilepsy, gram negativebacterial infections, aspergillosis, periodontal disease, Alzheimer'sdisease, cigarette smoke mediated lung inflammation, viral hepatitis(including hepatitis C virus hepatitis), alcoholic hepatitis, insulinresistance in adipocytes, and others. See, for example, United StatesPatent Application Publication No. US2008-0311112-A1, published Dec. 18,2008. The present invention may also be used, in non-limitingembodiments, to treat post traumatic conditions, including ischemicinjury and traumatic injury to the heart, liver, lung, kidney,intestine, brain, eye and pancreas.

Methods of Treatment

In a non-limiting embodiment, the present invention provides for amethod of treating an infectious or inflammatory disorder comprisingadministering, to a subject in need of such treatment, an effectiveamount of a T4IC that reduces one or more sign or symptom ofinflammation in the subject.

In another non-limiting embodiment, the present invention provides for amethod of treating an intestinal inflammatory disorder in a subjectcomprising administering, to a subject in need of such treatment, aneffective amount of a T4IC that reduces intestinal inflammation in thesubject.

In another non-limiting embodiment, the present invention provides for amethod of treating a cardiovascular disease in a subject comprisingadministering, to a subject in need of such treatment, an effectiveamount of a T4IC that reduces myocardial ischemia in the subject. Invarious non-limiting embodiments, the subject may be suffering fromcardiac angina, may have suffered or is suffering a myocardialinfarction, and/or may be at risk for suffering a myocardial infarction.

In another non-limiting embodiment, the present invention provides for amethod of treating an inflammatory pulmonary disease in a subjectcomprising administering, to a subject in need of such treatment, aneffective amount of a T4IC that reduces pulmonary airway inflammation inthe subject.

In another non-limiting embodiment, the present invention provides for amethod of treating a traumatic injury in a subject comprisingadministering, to a subject in need of such treatment, an effectiveamount of a T4IC that reduces TLR4-induced post-traumatic injury. Innon-limiting embodiments, the traumatic injury is to an organ selectedfrom the group consisting of the heart, the liver, the lung, the kidney,the intestine, the brain, the eye and the pancreas.

A subject may be a human or a non-human subject.

A T4IC may be administered by any standard route including but notlimited to oral, intraperitoneal (i.p), intravenous (i.v.), subcutaneous(s.c.), intradermal, intramuscular (i.m.) intraarticular, intrathecal,intraarterial, intravaginal, rectal, nasal, pulmonary, etc.

An effective dose may be determined using methods known in the art(including but not limited to TLR4 activity assays described herein). Inspecific, non-limiting embodiments of the invention, an effective dosemay be between about 0.01 and 50 micromoles of T4IC per kilogram weightof the subject, or between about 0.1 and 20 micromoles of T4IC perkilogram weight of the subject. In specific, non-limiting embodiments,the dose of T4IC may be between about 0.001 and 100 milligrams perkilogram weight of the subject, or between about 0.01 and 10 milligramsper kilogram weight of the subject, or between about 0.1 and 10milligrams per kilogram weight of the subject, or between about 0.5 and5 milligrams per kilogram weight of the subject.

EXAMPLE 1 Materials and Methods

In silico similarity screen. In order to identify inhibitors of TLR4,the structure of a known TLR4 inhibitor, E5564, was utilized. E5564 is asecond-generation synthetic analogue of the lipid A component ofendotoxin (lipopolysaccharide [LPS]). Based on the published structureof E5564, an in silico similarity screen was conducted using the on-lineiResearch library of ChemNavigator (San Diego, Calif.) accessed atwww.chemnavigator.com. This compound library was chosen to maximizestructural diversity while including drug-like structures, and also toinclude multiple Food and Drug Administration-approved drugs, knownbioactive compounds, metabolites, natural products and relatedcompounds.

Compound preparation and delivery. All 65 identified compounds werereceived in solid form and stored at 4° C. until use. Stock solutions ofeach compound were made by dissolving the appropriate amount of eachcompound in dimethyl sulfoxide (DMSO) to yield a concentration of 10 mM.Immediately prior to injection into experimental animals, the compoundswere diluted to an experimental concentration of 100 uM inphosphate-buffered saline (PBS). Total concentration of DMSO in thefinal diluted drug was 1%. Compounds were closely examined to insurethat no precipitate formed prior to injection and were stored on iceuntil injection. All compounds were given via intraperitoneal (i.p.)injection in a total volume of 200 ul using a 1 cc syringe and 27 gaugeneedle. In all experiments listed below, the compounds were delivered tothe experimental mice 30 minutes prior to injection withlipopolysaccharide (LPS) to induce endotoxemia. Control animals notreceiving compound received 1% DMSO dissolved in PBS. Following druginjection, the mice were observed closely in their cages for signs ofimmediate toxicity or adverse reaction to the drug, including but notlimited to piloerection, tachypnea, bleeding, abnormal or aggressivebehavior, signs of altered mental status, and level of activity.

Induction of endotoxemia. All mice were housed and cared for at theRangos Research Center, Children's Hospital of Pittsburgh (Pittsburgh,Pa.). All experiments were approved by the Children's Hospital ofPittsburgh Animal Care Committee and by the Institutional Review Boardof the University of Pittsburgh. Swiss Webster (CFW) and NFkB-luciferasereporter mice were obtained from The Jackson Laboratory. Throughout thecourse of all experiments, mice were housed 4 per cage with access tofood, water, and standard bedding. Endotoxemia was induced in allexperiments by i.p. injection of LPS (Escherichia coli 0111:B4 purifiedby gel filtration chromatography, >99% pure, Sigma-Aldrich) at a dose of2 mg/kg for 6 hours. At the end of each experiment, all animals wereeuthanized by CO2 hypoxia and cervical dislocation.

Two separate in vivo experimental designs were utilized to assess theeffect of pretreatment with each individual compound in a model ofendotoxemia. The first series of experiments involved the use of theNFkB reporter mice, while the second utilized CFW.

NFkB-luciferase reporter mice assay. NFkB-luciferase reporter mice, inwhich the NFkB is downstream of the luciferase gene, were subjected toendotoxemia with or without pretreatment with experimental compounds.The experimental compounds treated by this assay were compounds 1-6,with compounds 1-3 tested first and compounds 4-6 tested later. For bothexperiments, the mice were 6 weeks old on the date of the experiment.Controls for each included 1% DMSO alone, LPS alone (2 mg/kg, 6 hrs),and pretreatment with the known NFkB inhibitor Bay-11-7082 (20 mg/kg, 30minute pretreatment via i.p. injection, Cayman Chemical). Following 6hours of endotoxemia, each mouse was given an i.p. injection ofluciferin (160 ug/kg, Invitrogen), then after 10 minutes a whole animalimage was obtained using the IVIS Lumina 3D Optical in vivo imagingsystem (Caliper Life Sciences, Hopkinton, Mass.) under 1.5% isofluoraneanesthesia. After whole body imaging, an additional injection ofluciferin is given and animals were euthanized, organs were harvested,and the extent of NFkB activation within various tissues was furtheranalyzed by an additional luminescence image of the individual organs.

CFW endotoxemia assay. In order to effectively screen the entirecompound list, the remaining compounds (7-60) were screened in a modelof endotoxemia using CFW mice. Three separate experiments wereperformed: First, Compound 7 along with a repeat of compound 4 (n=3 miceper compound, mice age 5 weeks) were tested. Controls were salineinjection alone (n=1), LPS 2 mg/kg 6 hrs (n=2). Second, compounds 3, 4,6, 8-32 were tested (n=1 mouse each, 3 week old mice). Controls weresaline injection alone (n=1), LPS 2 mg/kg 6 hrs (n=2), LPS 10 mg/kg 6hrs (n=2), Bay 11 pretreatment 20 mg/kg for 30 minutes prior to LPS 2mg/kg 6 hrs. Third, compounds 8, 16, 33-60 were tested (n=1 mouse each,3 week old mice). Controls were saline injection alone (n=1), LPS 2mg/kg 6hrs (n=2), Bay 11 pretreatment 20 mg/kg for 30 minutes prior toLPS 2 mg/kg 6 hrs. Following 6 hours of endotoxemia, mice from thesecond and third experiments were observed within their cages andvideotaped to document behavior and phenotypic differences to assess foran inhibitory effect of compound pretreatment on the effects of LPS.Mice were identified by a number previously placed using permanentmarker on their tails. The degree of piloerection, tachypnea, locationin the cage (center of cage versus corners), degree of activity, andbehavior relative to other animals was observed and documented via videofor each mouse.

Enzyme linked immunosorbent assay (ELISA). Prior to being euthanized,mice from the NFkB luciferase and all three CFW endotoxemia experimentswere anesthetized (1.5% isofluorane) and a retro-orbital sinus puncturewas performed to obtain a blood sample. Serum was obtained viacentrifugation and an ELISA was performed to assess for IL-6 expressionusing a pre-made kit (R&D Biosystems). Results are reported relative toa standard curve for each experiment as pg/ml.

Results

With a view to identifying TLR4 inhibitors amongst previously knowncompounds (that were not hitherto known to have TLR4 inhibitoryactivity), a library of compounds was screened for those bearingstructural similarity to the known TLR4 inhibitor, E5564. A total of124,413,264 samples within the library were screened, and a total of 100structures were identified with a similarity greater than 70%. Excludingthe known TLR4 agonist, LPS, which was identified in the search, theremaining 99 compounds were then researched for commercial availability.A total of 65 commercially available compounds were identified andobtained in amounts ranging from 1-100 mg from ChemNavigator. These 65compounds are shown in TABLE 1. Compounds 9, 10, 11, 13, 14, 17, 21, 33and 35-39 are available from InterBioScreen Ltd., compounds 3, 5, 6, 8,23, 30 and 49-58 are available from Carbosynth Ltd., compounds 12, 22,24 and 34 are available from Enamine, compound 59 is available fromSynthon Lab Ltd., compounds 1, 4, 7, 15, 16, 18, 19, 32, 40, 41 and 60are available from Sigma-Aldrich, compounds 42 and 43 are available fromBosche Scientific LLC, compounds 2, 20, 25, 26, 27, 44, 45, 47 and 48are available from Toronto Research Chemicals, compound 65 is availablefrom PBMR Labs, Ukraine, compounds 31 and 46 are available fromMaybridge Ltd., compound 28 is available from Labotest and compounds 29and 61-64 are available from CehDiv Inc.

TABLE 1 Compound Stock ID IUPAC Name number 11(2S-2-((4aR,6R,7R,8R,8aS)-7-acetamido- 20107496-(2,3-bis(dodecyloxy)propoxy)-2,2-dimethylhexahydropyrano[3,2-d][1,3]dioxin-8-yloxy)propanoic acid 33 dodecyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxy-beta-D- 2010752glucopyranoside 14 butyl 2-(acetylamino)-2-deoxy-3,4-di-O-methyl-beta-D-2010750 glucopyranoside 34 isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside 2010760 35cyclohexyl 3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxy-alpha-D- 2010748glucopyranoside 36 hexyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxy-beta-D- 2010747glucopyranoside 37N-[(2R,3R,4R,5S,6R)-2-[(1′S,2′R,6′R,8′R,9′S)-dispiro[cyclohexane-1,4′-2010754 [3,5,7,10,12]pentaoxatricyclo[7.3.0.0^({circumflex over ( )}){2,6}]dodecane-11′,1″-cyclohexane]-8′-ylmethoxy]-4,5-dihydroxy-6-(hydroxymethyl)oxan-3-yl]acetamide 38(2R,3S,4R,5R,6R)-5-acetamido-2-(acetoxymethyl)- 20107536-(((3aR,5R,5aS,8aS,8bR)-2,2,7,7-tetramethyltetrahydro-3aH-bis[1,3]dioxolo[4,5-b:4′,5′-d]pyran-5-yl)methoxy)tetrahydro-2H-pyran-3,4-diyl-diacetate 21N-((2R,3R,4R,5S,6R)-4,5-dihydroxy-6-(hydroxymethyl)- 20107592-(((3aR,5R,5aS,8aS,8bR)-2,2,7,7-tetramethyltetrahydro-3aH-bis[1,3]dioxolo[4,5-b:4′,5′-d]pyran-5-yl)methoxy)tetrahydro-2H-pyran-3-yl) acetamide 12 propyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside 2010761 241,3,4,6-tetra-O-acetyl-2-deoxy-2-(palmitoylamino)hexopyranose 2010762 106-O-[2-(acetylamino)-2-deoxy-beta-D-glucopyranosyl]-3-O-isopentyl-2010757 1,2-O-(1-methylethylidene)-alpha-D-xylo-hexofuranose 396-O-[2-(acetylamino)-2-deoxy-beta-D-glucopyranosyl]-1,2-O-(1- 2010758methylethylidene)-3-O-propyl-alpha-D-xylo-hexofuranose 171,2-O-(1-methylethylidene)-3-O-propyl-6-O-[3,4,6-tri-O-acetyl-2- 2010755(acetylamino)-2-deoxy-beta-D-glucopyranosyl]-alpha-D-xylo-hexofuranose 91,2-O-(1-methylethylidene)-3-O-pentyl-6-O-[3,4,6-tri-O-acetyl-2- 2010756(acetylamino)-2-deoxy-beta-D-glucopyranosyl]-alpha-D-xylo-hexofuranose13 octyl 2-(acetylamino)-2-deoxy-beta-D-glycero-hexopyranoside 201075122 sec-butyl 2-(acetylamino)-2-deoxyhexopyranoside 2010763 19(2S,4S,5R,6R)-5-acetamido-2-((2R,3S,4S,5R,6S)- 20107453,5-dihydroxy-2-(hydroxymethyl)-6-((2R,3S,4R,5S)-4,5,6-trihydroxy-2-(hydroxymethyl)tetrahydro-2H-pyran-3-yloxy) 32 sodium(2S,3S,4R,5R,6R)-3-((2S,3R,5S,6R)- 20107393-acetamido-5-hydroxy-6-(hydroxymethyl)tetrahydro-2H-pyran-2-yloxy)-4,5,6-trihydroxytetrahydro-2H-pyran-2-carboxylate 12-(acetylamino)-4-O-{2-(acetylamino)-4-O-[2-(acetylamino)-2-deoxy-2010744 beta-D-glucopyranosyl]-2-deoxy-beta-D-glucopyranosyl}-2-deoxy-D-glucopyranose 43-acetamido-4,5-dihydroxy-6-(hydroxymethyl)tetrahydro-2H-pyran-2-yl2010742 dihydrogen phosphate, sodium salt 15 sulfuric acid compound with(2R)-4-amino-N-{(1R,2S,3S,4R,5S)-5- 2010737amino-2-[(3-amino-3-deoxy-alpha-D-glucopyranosyl)oxy]-4-[(6-amino-6-deoxy-alpha-D-glucopyranosyl)oxy]-3-hydroxycyclohexyl}-2-hydroxybutanamide (1:1) 40(4R)-4-((2S)-2-((2R)-2-((3R,4R,5S,6R)-3-acetamido- 20107462,5-dihydroxy-6-(hydroxymethyl)tetrahydro-2H-pyran-4-yloxy)propanamido)propanamido)-5-amino-5-oxopentanoic acid 41 Uridine5′-diphospho-N-acetylglucosamine sodium salt 2010741 18 Uridine5′-diphospho-N-acetylgalactosamine disodium salt 2010743 422-(acetylamino)-3-O-{4-O-[2-(acetylamino)-2-deoxy-3-O-alpha- 2010792D-xylo-hexopyranuronosyl-beta-D-ribo-hexopyranosyl]-beta-D-xylo-hexopyranuronosyl}-2-deoxy-D-glucopyranose 432-(acetylamino)-2-deoxy-3-O-(6,8-dideoxy-beta-L-glycero- 2010793octopyranosyl-7-ulose)-4-O-sulfo-L-erythro-hexopyranose 272-(acetylamino)-2-deoxy-4-O-hexopyranosylhexopyranose 2010777 2N-{(1S,2S,3R)-1-[(beta-L-glycero-hexopyranosyloxy)methyl]-2,3- 2010778dihydroxyheptadecyl}hexacosanamide 25 dimethyl5-(acetylamino)-3,5-dideoxy-D-erythro-non-2- 2010764 ulopyranosidonate20 methyl 2-(acetylamino)-2-deoxy-3-O-hexopyranosylhexopyranoside2010776 448-{[2-(acetylamino)-4-O-[2-(acetylamino)-2-deoxyhexopyranosyl]-2-2010781 deoxy-6-O-(6-deoxyhexopyranosyl)hexopyranosyl]oxy}octyl acetate26 octyl 2-(acetylamino)-2-deoxyhexopyranoside 2010775 452-(acetylamino)-2-deoxy-4-O-(6-deoxyhexopyranosyl)-3-O- 2010774hexopyranosylhexopyranose 312-(acetylamino)-2-deoxy-alpha-D-lyxo-hexopyranose 2010772 462-(acetylamino)-2-deoxy-D-glucopyranose 2010773 47 allyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxy-beta-D-lyxo- 2010780hexopyranoside 48N-{(1S,2R,3E)-1-[(beta-L-ribo-hexopyranosyloxy)methyl]-2-hydroxy-2010779 3-heptadecenyl}octadecanamide 49 sodium((3S,6R)-5-acetamido-3,4,6-trihydroxytetrahydro-2H-pyran- 20107872-yl)methyl phosphate 302-((2R,5S)-3-acetamido-2,5-dihydroxy-6-(hydroxymethyl)tetrahydro-2010782 2H-pyran-4-yloxy)propanoic acid 50 allyl2-(acetylamino)-2-deoxy-beta-D-glycero-hexopyranoside 2010765 511,3,4,6-tetra-O-acetyl-2-(acetylamino)-2-deoxy-beta-D-glycero- 2010766hexopyranose 52 2-(acetylamino)-2-deoxy-beta-D-glycero-hexopyranose2010769 53 4-O-[2-(acetylamino)-2-deoxyhexopyranosyl]-1,5-anhydro-2-2010791 deoxyhexitol 54 ethyl2-(acetylamino)-2-deoxy-beta-D-glycero-hexopyranoside 2010785 55 ethyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxy-beta-D-glycero- 2010784hexopyranoside 5 5-acetamido-6-((1R,2R>)-3-(3-(3-acetamido-5-hydroxy-6-2010770 (hydroxymethyl)-4-(3,4,5-trihydroxy-6-(hydroxymethyl)tetrahydro-2H>-pyran-2-yloxy)tetrahydro-2H-pyran-2-yloxy)-6-(4,5-dihydroxy-6-((E)-3-hydroxy-2-stearamidooctadec-4-e 8cyclohexanamine compound with 1,6-di-O-phosphono-beta-D- 2010788glycero-hexopyranose (4:1) hydrate 34-O-(3-O-{2-(acetylamino)-2-deoxy-4-O-(6-deoxyhexopyranosyl)-3-O-2010789 [2-O-(6-deoxyhexopyranosyl)hexopyranosyl]hexopyranosyl}hexopyranosyl)hexopyranose 63-O-(3-O-{2-(acetylamino)-2-deoxy-3-O-[2-O-(6- 2010783deoxyhexopyranosyl)hexopyranosyl]hexopyranosyl}hexopyranosyl)-D-arabinose 232-(acetylamino)-2-deoxy-3-O-(6-deoxyhexopyranosyl)-4-O- 2010790hexopyranosylhexopyranose 56 nonyl2-(acetylamino)-2-deoxy-beta-D-glycero-hexopyranoside 2010767 57octadecyl 2-(acetylamino)-2-deoxy-beta-D-glycero-hexopyranoside 201076858 4-O-{6-O-[5-(acetylamino)-3,5-dideoxy-D-erythro-non-2- 2010786ulopyranonosyl]hexopyranosyl}hexopyranose 592-deoxy-2-(propionylamino)-D-glucopyranose 2010771 7cyclohexane-1,2,3,4,5,6-hexayl hexakis(dihydrogen phosphate), 2010736magnesium potassium salt 601,3,4,6-tetra-O-acetyl-2-(acetylamino)-2-deoxy-beta-D- 2010738glucopyranose 16 2-(acetylamino)-2-deoxy-D-galactopyranose hydrate2010740 28 [(4R)-5-acetamido-3,4,6-triacetyloxy-oxan-2-yl]methyl 2017191acetate 61[5-acetamido-3-acetyloxy-2-(acetyloxymethyl)-6-hexadecoxy-oxan-4-2017186 yl] acetate 29(5-acetamido-3,4-diacetyloxy-6-pentoxy-oxan-2-yl)methyl acetate 201718762 (5-acetamido-3,4-diacetyloxy-6-methoxy-oxan-2-yl)methyl acetate2017188 63N-[2-ethoxy-4,5-dihydroxy-6-(hydroxymethyl)oxan-3-yl]acetamide 201718964 [2,5-diacetyloxy-6-(acetyloxymethyl)-3-(dodecanoylamino)oxan-4-yl]2017190 acetate 65 N-[2-(dispiro[BLAH]ylmethoxy)-4,5-dihydroxy-6-2017192 (hydroxymethyl)oxan-3-yl]acetamide

Next, 60 of the 65 compounds were tested to determine whether theyexhibit TLR4 inhibitory activity in a murine LPS-induced model forendotoxemia . The first series of experiments involved the use of theNFkB luciferase reporter mice (testing compounds 1-6), while the secondutilized CFW mice (testing compounds 3-65). In all cases, each mousereceived 20 nanomoles of test compound, or approximately 1 micromole perkilogram weight.

The results of the studies in NFkB luciferase reporter mice are shown inFIGS. 1-8; FIGS. 1-7 are photographs generated by the IVIS Lumina 3DOptical in vivo imaging system, and FIG. 8A-B are bar graphs summarizingthe results. Bay-11-7082 was used as a positive control for TLR4inhibitory activity. These results indicate that, at the concentrationtested, with the exception of compound 2, the other putative TLRinhibitors 1 and 3-6 all inhibited LPS-induced NFkB activation to someextent, with compound 4 having the greatest inhibitory activity in thisassay.

The results of the study of compounds 3-65 in the CFW endotoxemia modelare presented in TABLE 2 below. Less activity, tachypnea, andpiloerection are considered symptomatic of endotoxemia, so a decrease inthese is consistent with TLR inhibition by the administered compound.Note that compounds listed as negatives may still be T4Ics at otherconcentrations or conditions.

TABLE 2 Observation Compound “Hits”  3* More active, remained in centerrather than huddling in corner, less tachypneic, sniffing and crawlingover other affected micein cage  4* Appears similar to saline, robustactivity, self grooming and very active  8* More mobile, lesspiloerection 16* Nearly appeared unaffected, no piloerection obvious,very active, minimal tachypnea 21 More active, crawled over other mice,less piloerection 27* Less piloerection, less tachypnea, scattered whentop of cageremoved, jumping and moving throughout the cage unstimulated29 More mobile, less piloerection, less tachypnea, scattered when top ofcage removed 30 Less tachypnea, more mobile 34* Similar activity to C27,much more active, less tachypnea 35 More mobile, less piloerection, lesstachypnea, scattered when top of cage removed 36 More active, crawledover other mice, less piloerection 42 Less tachypnea, more mobile 43More active, crawled over other mice, less piloerection 45 More active,crawled over other mice, less piloerection 47 More active, crawled overother mice, less piloerection 50 More active 52 More active, lesspiloerection 54 Less piloerection, less tachypnea 55 Less piloerection,less tachypnea, more active 61 Less piloerection, less tachypnea 63 Moremobile, less piloerection Compound “Negatives”  1 More tachypnea, rigors 5* Little activity, huddled in corner, very tachynpeic, no resistanceto being handled 14 Refused to move from corner, very tachpneic 25 Morepiloerection, less mobile than other in the cage 31 More tachypneic,more piloerection 32 More tachypneic, more piloerection 37 Moretachypneic, less active 38 Less active 40 Less active, huddled in corner41 Less active, huddled in corner 62* Nearly static, little movement,rigors *Indicates most profound phenotypic differences from each group(positive or negative).

The results of the ELISA study showing IL6 production are presented inFIG. 9A.

EXAMPLE 2

Experiments were performed to further explore the activity of certain“positive” TLR4 inhibitors described in TABLES 1 and 2.

In a first set of experiments, NFKB luciferase reporter mice, asdescribed above, in which NFκB is downstream of the luciferase gene,were treated with either (i) saline (FIG. 10A, animal on the left); (ii)LPS alone (2 mg/kg; FIG. 10A, animal on the right)); (iii) LPS plus C16((1 mg/kg, intraperitoneal (i.p.) injection); FIG. 10B, animal on theleft) or (iv) LPS plus C34 ((1 mg/kg, i.p. injection); FIG. 10B, animalon the right). As the amount of luciferase reflects NFκB signalling, theimaging studies indicate that both compounds C16 and C34 reduced NFκBsignalling.

Inducible nitric oxide synthase (iNOS) is associated with necrotizingenterocolitis (NEC) in human infants. In a second set of experiments,the CFW-NEC mouse model system for NEC was used to evaluate the effectof various compounds from TABLES 1 and 2 above on iNOS mRNA levels. Amodel system for NEC was induced in newborn mouse pups by formulafeeding, where control animals were breast-fed (Sodhi et al., 2010,Gastroenterol. 138(1):185-196; Richardson et al., 2010, Gastroenterol.139(3):904-917). As shown in FIG. 11, the level of iNOS wassubstantially increased in the formula-fed (FF) group. This increase wasmuch less when FF pups were also administered C27 (1 mg/kg, i.p., oncedaily for the first four days of the five day model) and the increasewas almost eliminated by C34 (1 mg/kg, i.p., once daily for the firstfour days of the five day model). Note that RPLO stands for 50Sribosomal subunit protein L15, an acknowledged housekeeping gene, whichmeans that it is a constitutive gene expressed at relatively constantlevels by all cells and is thus used as a reference for comparing othergenes which may vary under experimental conditions. In this same modelsystem, levels of TLR4 mRNA levels were also evaluated. The level ofTLR4 mRNA seen in breast-fed animals, including breast-fed animalstreated with C34, was substantially increased in the FF animals. Incontrast, the level of TLR4 was not increased in FF animals treated withC34 (1 mg/kg, i.p. once daily for the first four days of the five daymodel) and indeed mRNA levels were 30 percent below normal (see FIG.14).

The effect of C34 was then tested on explants of human NEC tissue. Theseexplants were obtained from human infants suffering from NEC and wereprepared from NEC-affected portions of the intestine. When explants weretreated with LPS (25 ug/ml, 37° C., 3 hours) the level of TNFα mRNA(FIG. 12) and iNOS mRNA (FIG. 13) increased precipitously. Theseincreases were substantially reduced by treatment with C34 (10 uM,tissue was pretreated for 30 minutes prior to LPS being added; C34 wasnot removed and remained in solution during incubation with LPS; FIGS.12 and 13).

All the foregoing data supports the use of compounds C34, C16 and C27 asTLR4 inhibitors, as inhibitors of inflammation, and as inhibitors andagents for treatment of NEC.

EXAMPLE 3

An experiment was performed to test the effect of TLR4 inhibitors andC34 in particular on the tissue damage associated with hemmorhagicshock. A murine model was used in which, under sterile conditions andanesthesia induced using i.p. sodium pentobarbital (20 mg/kg), a leftgroin exploration was performed, and the left femoral artery wascannulated with tapered polyethylene (PE)-10 tubing and connected to ablood pressure transducer for continuous mean arterial pressure (MAP)monitoring for the duration of the experiment (6 h) as described inSodhi, et al., 2011, Am. J. Physiol. Gastrointest. Liver Physiol.300(5):G862-G873. To induce hemorrhagic shock, blood was withdrawn toallow the mean arterial pressure to drop to 25 mmHg over 5 minutes, andthe blood pressure was maintained at this level for 150 min. The micewere then resuscitated over 10 min with lactated Ringer's solution.Sham-operated mice underwent anesthesia and femoral cannulation only. Inthis model system, the extent of liver damage is reflected in increasedserum levels of aspartate aminotransferase (AST) and alaninetransaminase (ALT). As shown in FIG. 15A-B, administration of C34 (1mg/kg, i.p. divided in two doses with one given 30 minutes prior to H/Sand the second given immediately prior to resuscitation) inhibited theincreases in AST (FIG. 15A) and ALT (FIG. 15B) observed in H/S animalsreceiving phosphate buffered saline (PBS), supporting the effectivenessof compound C34 in reducing the extent of tissue damage/injuryassociated with trauma and/or shock.

EXAMPLE 4 Synthesis of Isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside (C34)

2-Acetamido-2-deoxy-1,3,4,6-tetra-O-acetyl-β-D-glucopyranose. A dry, 100mL round-bottom flask was equipped with a Teflon coated stir bar, septumand an ice-salt bath. The flask was put under an argon atmosphere andacetic anhydride (8.40 g, 7.76 mL, 82.27 mmol) which was stored in thefreezer at 5° C. was added via syringe. The acetic anhydride was cooledfor 15 min at 0° C. After 15 min, the septum was replaced with a funneland N-acetyl-D-glucosamine (0.692 g, 3.13 mmol) and montmorillonite K-10(2.4 g) were added sequentially and slowly over 15 min. The stopper wasthen replaced the ice bath removed and the reaction was stirred for 24hours. The reaction mixture was then filtered through a medium porositysintered glass funnel precoated with a pad of celite moistened by methylacetate. The flask and filtered solids were rinsed with methyl acetate(100 mL) and the combined filtrate was concentrated under rotaryevaporation (40° C.). The resulting orange residue was dislodged with aspatula and twice recrystallized from hot methanol (2 mL) over 24 h inan explosion proof freezer. The solution was decanted by pipette and thecrystals were rinsed with ice-cold diethyl ether (3×2 mL) to afford2-Acetamido-2-deoxy-1,3,4,6-tetra-O-acetyl-β-D-glucopyranose as a whitecrystal solid (350.2 mg, 29%). ¹H-NMR (400 MHz, CDCl₃): δ 5.69 (d, J=8.8Hz, 1H), 5.41 (d, J=9.6 Hz, 1H), 5.17-5.09 (m, 2H), 4.33-4.25 (m, 2H),4.13 (dd, J=2.4, 12.6 Hz, 1H), 3.78 (ddd, J=2.4, 4.4, 9.6 Hz, 1H), 2.12(s, 3H), 2.09 (s, 3H), 2.05 (s, 3H), 2.04 (s, 3H). Note: Commerciallyavailable through Alfa Aesar (Cat. No.=L09020). See Knapp et al., 2009,Organic Synthesis 84:68-76.

2,3-Dihydrooxazole-3,4,6-tri-O-acetyl-β-D-glucopyranoside.2-Acetamido-2-deoxy-1,3,4,6-tetra-O-acetyl-β-D-glucopyranose (299 mg,0.768 mmol) was dissolved in dichloroethane (21.3 mL, 0.036 M) in a 100mL round bottom flask and then trimethylsilyl trifluoromethanesulfonate(TMSOTf, 0.149 mL, 0.806 mmol, 1.05 eq) was added. The mixture wasstirred at 50° C. for 55 min after which TLC (100% EtOAc) indicated fullconversion. The mixture was then removed from the heat and triethylamine(0.327 mL, 2.30 mmol, 3 eq) was added. The mixture was then stirred atroom temperature for 10 min and then passed through a short plug ofsilica which was washed carefully with dichloromethane (25 mL) and EtOAc(15 mL). The solvent was removed under reduced pressure and the crudeorange oil was purified by flash chromatography with 100% EtOAc (thecolumn was based washed with 1% triethylamine in EtOAc prior to use)giving 2,3-Dihydrooxazole-3,4,6-tri-O-acetyl-β-D-glucopyranoside (238.2mg, 94%) as a colorless oil. ¹H-NMR (500 MHz, CDCl₃): δ 5.96 (d, J=7.5Hz, 1H), 5.25 (app. t, J=2.5 Hz, 1H), 4.92 (dq, J=1.5, 9.3 Hz, 1H),4.17-4.11 (m, 3H), 3.61-3.56 (m, 1H), 2.10 (s, 3H), 2.09 (s, 3H), 2.08(d, J=2 Hz, 3H), 2.07 (s, 3H). ¹³C-NMR (100 MHz, CDCl₃): δ. 170.6,169.5, 169.2, 166.7, 99.4, 70.4, 68.4, 67.5, 65.0, 63.3, 20.9, 20.8,20.7, 14.0. See Norberg et al., 2011, Analytical Chem. 83:1000-1007.

Isopropyl 3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside.2,3-Dihydrooxazole-3,4,6-tri-O-acetyl-β-D-glucopyranoside (0.140 g,0.424 mmol) and anhydrous CuCl₂ (57 mg, 0.424 mmol, 1 eq) werecoevaporated with toluene (Note: some material was lost due to themixture bumping on the rotovap and this is reflected in the yield).Anhydrous chloroform (0.80 mL, 0.53 M) and anhydrous 2-propanol (0.13mL, 1.72 mmol, 4.05 eq) were added to the sugar and CuCl₂ in a 5 mLconical sealed vessel under argon atmosphere and the reaction mixturewas heated at 62° C. for 2.25 hr. After cooling to room temperature, themixture was diluted with acetone (15 mL) and saturated aqueous sodiumbicarbonate (7 mL) and the precipitated copper carbonate salts wereremoved by filtration through a short plug of celite which was washedwith acetone (20 mL). The filtrate was removed and the residuecoevaporated with toluene to remove residual water. The remainder wasshaken with chloroform and weakly acidic ion-exchange resin (AmberliteIRC-86, ca 1.5 g) in order to remove remaining sugar-oxazoline startingmaterial. Filtration, evaporation and flash chromatography (hexane/ethylacetate, 1:3, Rf=0.24) gave isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside (80.3 mg, 49%)as a white solid. ¹H-NMR (400 MHz, CDCl₃): δ 5.57 (d, J=8.0 Hz, 1H),5.40 (dd, J=9.6, 10.4 Hz, 1H), 5.02, (app. t, J=9.6 Hz, 1H), 4.83 (d,J=8.0 Hz, 1H), 4.24 (dd, J=4.8, 12.2 Hz, 1H), 4.11 (dd, 2.4, 12.0 Hz,1H), 3.92 (sept, J=6 Hz, 1H), 3.73-3.61 (m, 2H), 2.07 (s, 3H), 2.02 (s,3H), 2.01 (s, 3H), 1.93 (s, 3H), 1.22 (d, J=6.4 Hz, 3H), 1.13 (d, J=6.0Hz, 3H).¹³C-NMR (100 MHz, CDCl₃): δ 170.7, 170.7, 170.2, 169.5, 99.18,72.6, 72.2, 71.6, 69.0, 62.4, 55.6, 23.3, 23.3, 22.0, 20.7, 20.7, 20.6.HRMS (+ESI-TOF) calcd for C₁₇H₂₇NO₉Na [M+Na]: 412.1584. Found: 412.1555.See Wittmann et al., 2002, Eur. J. Org. Chem. 8:1363-1367.

Various publications are cited herein, the contents of which are herebyincorporated by reference in their entireties.

We claim:
 1. A method of treating an infectious or inflammatory disordercomprising administering, to a subject in need of such treatment, aneffective amount of a Toll-like receptor 4 inhibitor compound selectedfrom the compounds listed in TABLE 1 that reduces one or more sign orsymptom of inflammation in the subject.
 2. The method of claim 1 wherethe subject is suffering from sepsis.
 3. The method of claim 1 where thesubject is suffering from arthritis.
 4. The method of claim 1, where theToll-like receptor 4 inhibitor compound is selected from the groupconsisting of isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside,2-(acetylamino)-2-deoxy-D-galactopyranose hydrate, and2-(acetylamino)-2-deoxy-4-O-hexopyranosylhexopyranose.
 5. The method ofclaim 1, where the Toll-like receptor 4 inhibitor is a derivative ofisopropyl 3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside.administering, to a subject in need of such treatment, an effectiveamount of a T4IC selected from the compounds listed in TABLE 1 thatreduces intestinal inflammation in the subject.
 7. The method of claim 6where the subject is suffering from necrotizing enterocolitis.
 8. Themethod of claim 6 where the subject is suffering from ulcerativecolitis.
 9. The method of claim 6 where the subject is suffering fromCrohn's disease.
 10. The method of claim 6, where the Toll-like receptor4 inhibitor compound is selected from the group consisting of isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside,2-(acetylamino)-2-deoxy-D-galactopyranose hydrate, and2-(acetylamino)-2-deoxy-4-O-hexopyranosylhexopyranose.
 11. The method ofclaim 6, where the Toll-like receptor 4 inhibitor is a derivative ofisopropyl 3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside. 12.A method of treating a cardiovascular disease in a subject comprisingadministering, to a subject in need of such treatment, an effectiveamount of a Toll-like receptor 4 inhibitor compound selected from thecompounds listed in TABLE 1 that reduces myocardial ischemia in thesubject.
 13. The method of claim 12, where the subject is suffering fromangina.
 14. The method of claim 12, where the subject has suffered amyocardial infarction.
 15. The method of claim 12, where the subject isat increased risk of suffering a myocardial infarction.
 16. The methodof claim 12, where the Toll-like receptor 4 inhibitor compound isselected from the group consisting of isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside,2-(acetylamino)-2-deoxy-D-galactopyranose hydrate, and2-(acetylamino)-2-deoxy-4-O-hexopyranosylhexopyranose.
 17. The method ofclaim 12, where the Toll-like receptor 4 inhibitor is a derivative ofisopropyl 3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside. 18.A method of treating a traumatic injury in a subject comprisingadministering, to a subject in need of such treatment, an effectiveamount of a Toll-like receptor 4 inhibitor compound selected from thecompounds listed in TABLE 1 that reduces Toll-like receptor 4-inducedpost-traumatic injury.
 19. The method of claim 18, where the traumaticinjury is to an organ selected from the group consisting of the heart,the liver, the lung, the kidney, the intestine, the brain, the eye andthe pancreas.
 20. The method of claim 18, where the Toll-like receptor 4inhibitor compound is selected from the group consisting of isopropyl3,4,6-tri-O-acetyl-2-(acetylamino)-2-deoxyhexopyranoside,2-(acetylamino)-2-deoxy-D-galactopyranose hydrate, and2-(acetylamino)-2-deoxy-4-O-hexopyranosylhexopyranose.